Cardiovascular disease after traumatic brain injury: the heart of the matter.
Cardiovascular disease after traumatic brain injury: the heart of the matter.
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脑外伤后的心血管疾病：问题的核心。
DOI：
10.1016/s1474-4422(23)00312-5
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Dams-O'Connor,Kristen
中科院分区：
文献类型：
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作者：
Dams-O'Connor,Kristen
《柳叶刀》委员会关于痴呆症预防、干预和护理的2020年报告1总结了创伤性脑损伤（TBI）与痴呆症之间关联的证据，并将TBI添加到该疾病的其他11个可改变的风险因素中。其中一些可改变的风险因素也与心血管疾病有关（即高血压、肥胖、缺乏运动、糖尿病、过量饮酒、吸烟和空气污染）。在《柳叶刀神经病学》中，Saef Izzy及其同事2总结了脑损伤（作者用来描述TBI和重复性头部撞击（RHI）的术语）与心血管疾病风险增加和心血管风险因素之间相关性的证据。心血管疾病被证明是脑损伤和痴呆之间有据可查的关联的可改变的介导者。这一概念与TBI作为一种慢性疾病的不断发展的概念是一致的，影响多个身体系统和健康和功能领域。3为了将这一概念转化为个人层面上可行的风险缓解策略，有必要确定某些类型的头部创伤如何以及对谁来说会增加神经退行性和血管性脑病变的风险。脑损伤导致脑病理的途径可能因头部创伤的原因和模式而异。体内和尸检证据表明，在有头部创伤史的个体中观察到的神经退行性疾病的潜在病理可能不同。心血管危险因素（以及随之而来的脑血管疾病）的差异也可能存在于具有一种或多种类型头部创伤的亚组中。
The 2020 report of the Lancet Commission on dementia prevention, intervention, and care1 summarised the evidence for the association between traumatic brain injury (TBI) and dementia, and added TBI to a list of 11 other modifiable risk factors for this condition. Several of these modifiable risk factors are also associated with cardiovascular disease (ie, hypertension, obesity, physical inactivity, diabetes, excessive alcohol consumption, smoking, and air pollution). In The Lancet Neurology, Saef Izzy and colleagues2 summarise the evidence for the association between brain injury—a term used by the authors to describe both TBI and repetitive head impacts (RHIs)—and an increased risk of cardiovascular disease and cardiovascular risk factors. Cardiovascular disease is shown to be a modifiable mediator of the well documented association between brain injury and dementia. This notion is consistent with the evolving conceptualisation of TBI as a chronic disease, affecting multiple body systems and domains of health and function. 3 For this notion to be translated into actionable riskmitigation strategies at the individual level, it will be necessary to determine how, and for whom, some types of head trauma increase the risk for neurodegenerative and vascular brain pathologies. The pathways through which brain injury contributes to brain pathologies might differ according to the causes and patterns of the head trauma. In-vivo and post-mortem evidence suggests that the underlying pathologies of neurodegenerative disease seen in individuals with a history of head trauma can differ. Differences in cardiovascular risk factors (and consequent cerebrovascular disease) might also exist across subgroups with one or more types of head trauma.